Q&A: How 'Long COVID' Is Impacting San Diegans
Just like the pandemic itself, the COVID-19 virus can have long-term consequences. An estimated 10% of people who’ve been sickened by the virus have developed what’s being called “long COVID,” an array of symptoms that linger, sometimes months after their initial illness. A new clinic has been established by UC San Diego to treat these COVID-19 long haulers, and to research how the virus can cause these long-term effects.
Dr. Lucy Horton, founder of UC San Diego Health's post-acute COVID-19 telemedicine clinic, joined Midday Edition on Tuesday to talk about the impacts long-term COVID-19 is having in San Diego. The interview below has been lightly edited for clarity.
Q: I said about 10% of COVID-19 patients develop lingering symptoms. Is that right? I've heard the percentage could be higher.
A: Great question. So there's not a lot of great data on it. Reports have estimated between 10 to 30%. But I suspect that we're really only seeing the tip of the iceberg here. There's probably a lot more patients that are suffering from "long COVID" who just haven't presented to care yet or aren't aware that their symptoms are those of "long COVID-19."
Q: What are the most common complaints and complications that you're seeing in people who have recovered from COVID-19 but have these long term complications?
A: Well, the symptoms vary greatly among patients and they really reach the whole spectrum in terms of different organ systems involved. Some of the most common symptoms we see are persistent fatigue, reduced exercise tolerance, post-exertional malaise, feeling really exhausted and crummy after minimal activity. There are neurologic components like brain fog, headaches, difficulty with memory or concentrating. We see some cardiovascular effects. So, issues with rapid heart rate, difficulty controlling the blood pressure. There are some lingering respiratory symptoms in some patients, for example, chronic cough, development of asthma, difficulty breathing. Some patients may have chronic nausea, diarrhea. You know, there's really quite a range of symptoms. I think the ones that really are the most prominent that the majority of patients experience is some form of fatigue and muscle ache and the sensation of brain fog.
Q: Can you describe that brain fog that lingers for some people? How does it affect people's lives?
A: Yeah, it's a really concerning symptom because it really does affect people's ability to return to their pre-COVID lives. The brain fog is often described to me by patients as feeling like they're just not as sharp as they used to be. Their reactions are delayed. I'll give you an example. I had a patient who told me that she had set up a Zoom meeting with colleagues, and when she logged on to the Zoom meeting, she just couldn't remember why she had even set up the meeting. And she had to ask them why are we meeting? And that caused a lot of distress. You know, she's worried about losing her job because she's not performing well and her colleagues are worried about her. You know, people describe getting in their car to go drive somewhere and not really remembering where they're going to drive. Difficulty concentrating on tasks. I have a couple of patients who are lawyers who say when they sit down to read some of the legal documents, it's very exhausting and fatiguing because they're trying to concentrate and they just feel like they're not as sharp as they used to be.
Q: Dr. Horton, are the people who suffer from "long COVID" the same high risk individuals for serious COVID-19 illness? And I'm talking about people over 65 with underlying conditions.
A: So there are some of those patients, those high-risk patients who may have been hospitalized, who might have even been in the intensive care unit, who have persistent symptoms, but the majority of the patients that we're seeing with more of the classic "long COVID" actually had mild-to-moderate disease. So most of them were never hospitalized, never needed to go to the emergency room. A lot of them come from younger age groups. So people in their 20s to 50s who didn't really have a lot of underlying conditions, we definitely do not see as many who have those kind of high-risk conditions like diabetes, obesity, immunocompromise. I will note that some of those patients who had the more severe disease were high risk. They may continue to have symptoms more related to the severity of their initial illness and the fact that they were in the ICU. And so there is a little bit of an overlap in the two conditions at times.
Q: Does getting a COVID-19 vaccine help resolve "long COVID" symptoms?
A: I have seen anecdotal reports from across the country of patients who report improvement or even complete resolution of their symptoms after getting a vaccine. We just don't have a lot of experience here since very few of our "long COVID" patients have been vaccinated yet. But if it does in fact provide some therapeutic benefit to them, I think that would be wonderful. And, you know, just another great reason to get vaccinated.
Q: Now, you've told us that many of the people suffering from "long COVID" don't fit the profile of high-risk individuals. They tend to be younger. And that kind of flies in the face of the idea that COVID-19 is not really risky for younger people, doesn't it?
A: It certainly does. And if there's one message I can give to younger people who don't think that COVID-19 is going to affect them and may not be that concerned about catching COVID-19, I would, you know, educate them about the potential of, you know, progressing to becoming a long hauler and getting these symptoms. I think it's really quite concerning how many younger, healthier people have developed "long COVID" and we really don't have a good understanding at this point why that is and what are the underlying risk factors for developing "long COVID." So really, everyone is at risk and everyone should continue to protect themselves as best as possible.
Q: Do we know how long "long COVID" actually is?
A: We don't. So we've only known this virus for about 15 months now. So, I can tell you that some people have symptoms past a year, but we really don't know if it's going to last a lot longer. I suspect based on what we know about other chronic conditions or chronic sequelae of viral infections, that there is going to be a small subset that may have symptoms their entire life. There will also be a good number who hopefully would recover within one to three years.